Application of intracranial lead reconstruction in deep brain stimulation therapy in patients with Parkinson's disease / 南方医科大学学报

OBJECTIVE@#To evaluate the feasibility of applying intracranial lead reconstruction in deep brain stimulation (DBS) therapy for Parkinsonism.@*METHODS@#We retrospectively collected the clinical data from 27 patients with Parkinson's disease (PD), who received bilateral subthalamic nucleus (STN) DBS therapy between January, 2016 and December, 2017. According to the position of the selected optimal stimulating contact of the implanted leads, the patients were divided into group A with the stimulating contacts of the bilateral leads in the STN, group B with unilateral stimulating contacts in the STN, and group C with bilateral stimulating contacts outside the STN. All the patients were assessed for improvement using Hoehn-Yahr stage, the third part of United Parkinson's Disease Rating Scale (UPDRS Ⅲ), Schwab and England Activities of Daily Living (SE-ADL), and L-dopa equivalent daily dose (LEDD). The consistency between the optimal stimulating contact selected by lead reconstruction and that by standard postoperative programming procedure was also evaluated.@*RESULTS@#The patients in all the 3 groups showed postoperative improvements in Hoehn-Yahr stage, UPDRS Ⅲ score, SE-ADL score, and LEDD in the medication-off state. But at 12 months of the follow-up, such improvements were maintained only in the patients of group A. The optimal stimulating contacts selected by lead reconstruction and standard postoperative programming procedure had a matching rate of up to 77.78% (42/54), and the coordinates of the optimal contacts selected by the two methods showed no significant difference.@*CONCLUSIONS@#Intracranial lead reconstruction facilitates the study of the association between the implant site of the leads and the clinical outcome of DBS therapy for PD and allows the precise selection of the optimal contact of the implanted leads in postoperative programming of DBS.

A case control study of distance change of bilateral internal carotid artery in acromegaly / 中国神经精神疾病杂志

Objective To investigate the distance change of bilateral internal carotid artery in acromegalic patients. Methods Twenty patients with acromegaly were included in this study from August 2016 to March 2018 in Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical University. There were 7 males and 13 females with an average age of 40.2±12.6 years (range from 21 to 62 years old). Forty sex and age matched patients with non-functional pituitary adenoma were selected as controls. The 3D printing software was used for reconstructing the internal carotid artery. Distances of the bilateral internal carotid arteries were measured on the reconstructed images. Results The maximum distance between bilateral siphon carotid ectasias (25.1±3.9 mm vs. 23.2±2.9 mm, P=0.041) and distance between bilateral lacerum segments (26.2 ±3.1 mm vs. 23.8 ±4.1 mm, P=0.022) were significantly longer in patients with acromegaly than in those without. Although the distance between bilateral cavernous segments (20.7 ±4.3 mm vs. 22.4 ±3.1 mm, P=0.076) tended to be shorter, the difference was not statistically significant. The distance between bilateral ophthalmic segments was not significantly different between the two groups (15.7±5.1 mm vs. 16.0±2.5 mm, P=0.783). Conclusion The distance of bilateral internal carotid artery of acromegalic patients is different from that of patients with non-functional pituitary adenomas. Patients with acromegaly have significantly longer distance between bilateral siphon carotid ectasias and distance between bilateral lacerum segments compared with the patients with non- functional pituitary adenomas.

Construction and application of 3D printing model of endoscopic endonasal transsphenoidal surgical training / 中国神经精神疾病杂志

Objective The aim of our study was to establish an endoscopic endonasal transsphenoidal surgical training model, and to examine its application value. Methods The endoscopic endonasal transsphenoidal surgical training models were made.After assessments,the models was used for endoscopic operation training for 8 neurosurgeons with no experiences of endoscopic operation. Results The available operating space of this model is similar to the actual operating space in endoscopic endonasal transsphenoidal surgery. The egg fixed on the model has many layers of structure, such as eggshell, shell membrane, egg white and egg yolk, which constituted a good practice object. All students indicated that they could benefit from the training using this model. The skill in grinding the eggshell [(1.07 ± 0.221)cm2/min vs.(1.45±0.27)cm2/min, P<0.001]was significantly improved and the chance for shell membrane rupture (8 vs. 2, P=0.007) was significantly reduced in the last-time practice compared with the first-time practice (P<0.001). Conclusion The endoscopic endonasal transsphenoidal surgical training model is helpful for neurosurgeons to practice the basic operation of endoscopic surgery and to improve their surgical skills,and can be used repeatedly.It can be used in basic operation training before the training using cadaver cranium.

A risk factors analysis on biochemical remission of pituitary tumor patients with acromegaly treated by the endoscopic endonasal surgery / 中国神经精神疾病杂志

Objective To study the risk factors of the biochemical remission of pituitary tumor patients with acromegaly treated by the endoscopic endonasal surgery. Methods A retrospective analysis of clinical data was conducted on 61 cases acromegaly patients underwent endoscopic endonasal surgery between August 2013- November 2016.Endocrinology tests were performed in all patients,including the fasting/random GH(growth hormone,GH)level, Nadir GH during OGTT(oral glucose tolerance test, OGTT), and IGF-1(insulin-like growth factor-1,IGF-1). The clinical data included gender, age, preoperative GH value, preoperative IGF-1 value, tumor invasion of the inferface space of internal carotid artery(ICA),tumor surrounding angle of internal carotid artery(≥/<135°),Knosp grade, Hardy grade, and tumor volume. Univariate analysis and multivariate Logistic retrospective analysis were used to analyze the association between above-mentioned factors and the occurrence of biochemical remission. Results There were 52.5% (32/61)patients achieving biochemical remission.Univariate analysis showed significant differences between patients with and without biochemical remission in preoperative GH value, tumor surrounding angle of internal carotid artery(</≥135°)and Knosp grade(P<0.05).The Logistic regression analysis showed that preoperative GH value,tumor surrounding angle of internal carotid artery(</≥135°)were risk factors concerning about the biochemical remission in patients underwent endoscopic endonasal surgery.(P<0.05). Conclusion Tumor surrounding angle of internal carotid artery(≥135°)is independent risk factors, while the preoperative GH value is a risk predictor of biochemical remission after endoscopic endonasal surgery in acromegaly.

Effect of butylphthalide injection on serum neuron specific enolase, C-reactive protein and fatty acid binding protein levels in patients with cerebral vasospasm following aneurysmal subarachnoid hemorrhage / 中国生化药物杂志

To investigate influence of butylphthalide injection on serum neuron specific enolase, C-reactive protein and fatty acid binding protein levels in patients with cerebral vasospasm following aneurysmal subarachnoid hemorrhage.Methods Ninety patients with cerebral vasospasm were admitted to The First Affiliated Hospital of Fujian Medical University, then the patients were divided into two groups: The control group (45 patients) was treated with nimodipine and triple-H therapy after surgery;in addition to nimodipine and triple-H therapy, butylphthalide injection was administered to the experimental group(45 patients).Transcranial doppler(TCD)was used for the evaluating cerebral artery blood flow velocity, and the serum neuron specific enolase(NSE), C-reactive protein(CRP) and fatty acid binding protein(FABP) levels in patients with cerebral vasospasm were measured. Results The experimental group improved significantly more than the control group, a significant decrease in cerebral blood flow velocity of the middle cerebral artery in the experimental group as measured by TCD (P<0.05).The serum levels of NSE, CRP and FABP in the patients in the experimental group decreased more significantly (P<0.05).And the incidence of cerebral infarction in experimental group was lower than that in control group (P<0.05).Conclusion The serum levels of NSE, CRP and FABP in the patients with cerebral vasospasm following aneurysmal subarachnoid hemorrhage could be significantly reduced by administration of butylphthalide injection, which also could improve cerebral blood supply.Therefore, administration of butylphthalide injection is an effective treatment for cerebral vasospasm.

The establisment of human craniopharyngioma xenografts in chick chorioallantoic membrane / 中国神经精神疾病杂志

Objective To establish the xenotransplanted tumor model of Craniopharyngioma in chick chorioallan?toic membrane (CAM) and detect the angiogenesis ability, microvessel density (MVD) and cell proliferation of the xeno?graft. Method Craniopharyngioma tissues from surgical craniopharyngioma patients were transplanted on the CAM. An?giogenesis assay was performed and the MVD and PCNA were evaluated using immunohistochemistry following the trans?plantation. Results The tumor formation rate of adamantinomatous craniopharyngioma (ACP) and squamous papillary cra?niopharyngioma (SPCP) was 47.14% and 43.33%, respectively. There was no significant difference in tumor formation rate between ACP and SPCP(χ2=0.123,P=0.726). The CAM angiogenesis, MVD and expression of PCNA were higher in ACP than in SPCP. The expression of PCNA was positively correlated with MVD (Pearson r=0.639,P<0.001) and CAM assay score (Spearman r=0.490,P=0.001 ) in CP. Conclusion The model of human craniopharyngioma can be es?tablished in the CAM. The angiogenesis of the xenograft in the CAM can be evaluated and the craniopharyngioma xeno?graft of CAM possesses a new blood circulation and cell proliferation ability.

Factors affecting progression-free survival of patients with cerebral hemisphere high-grade glioma after total resection / 中国神经精神疾病杂志

Objective The purpose of this study was to assess the imaging features of newly diagnosed high-grade glioma and the effect of relevant factors such as postoperative radiotherapy and chemotherapy on progression-free sur-vival (PFS) time. Methods A total of 54 patients with recurrent high-grade glioma confirmed by pathology or progressive malignant glioma proved by clinical follow-up were included in this retrospective study from 4 clinical centers. The prog-nostic factors selected included MR image features at initial diagnosis (including the maximum diameter of tumor, peritu-moral edema, degree of enhancement, degree of necrosis and presence of cystic or satellite), postoperative radiotherapy and chemotherapy. Kaplan-Meier method and Cox’s proportion-hazards model were used to analyse the factors influenc-ing the progression free survival (PFS) time. Results The univariate Kaplan-Meier analysis revealed that the degree of peritumoral edema (PTE, P=0.001), degree of necrosis (P<0.001) , degree of enhancement (P<0.001), postoperative radio-therapy (P=0.008) and chemotherapy(P=0.035) were significant factors for PFS. Cox multivariate analysis also showed that the degree of PTE(P=0.019),degree of necrosis (P<0.001) were all significantly correlated with PFS. The less edema or necrosis was associated with the longer PFS. In addition, postoperative radiotherapy (P=0.035) and chemotherapy (P=0.049) were also significantly correlated with PFS. The normative chemotherapy and radiotherapy were associated with longer PFS. Conclusions The PTE and necrosis on preoperative MR images can be used to predict the PFS of glioma af-ter total resection. Adjuvant normative chemotherapy and radiotherapy should be recommend for supratentorial high-grade glioma including those even with MRI confirmed total resection.

The influence of peritumoral edema at newly diagnosed glioma on recurrence patterns after total resection / 中国神经精神疾病杂志

Objective To explore the influence of peritumoral edema (PTE) on the tendency of recurrent location and morphological character after total resection using MRI. Methods MRI data was collected from 43 patients with recur-rent brain glioma after total resection from four clinical centers and then the influence of of PTE on recurrence patterns af-ter total resection was retrospectively analyzed based on the T2 weighted image. Results The PTE had a significant influ-ence on the recurrent patterns of brain gliomas after total resection. When PTE was mild, the shapes of recurrent gliomas tended to be focal (6/8) and the recurrent locations tended to be local (5/8). When PTE was severe, the shapes of the recur- rent gliomas tended to be spread(30/35 and the recurrent locations tended to be distant (25/35), followed by marginal (7/35), In addition, the morphological patterns and locations of recurrent gliomas were significantly different among different PTE types (all P<0.001). When PTE was ring shape, the shapes of recurrent gliomas tended to be focal (7/9) and the recur-rent locations tended to be local (6/9), followed by marginal (2/9) and distant (1/9). When PTE was irregular shape, most of recurrent locations tended to be distant (25/34), followed by marginal (7/34) but rarely local (2/34). Conclusions The de-grees and the types of brain glioma PTE can significantly influence the locations and morphological patterns of recurrent gliomas after total resection.

The primary application of intra-operative evoked potentials monitoring in microsurgery of intracranial aneurysms / 中国神经精神疾病杂志

Background Although remarkable progress has been made in microsurgery, surgery of intracranial aneurysm still encounters various complications. Cerebral ischemia and postoperative disorders of nervous system could be induced by various specific operation procedures. To improve the outcomes in intracranial aneurysm surgery and to minimize the occurrence of postoperative ischemic complications, it is necessary to perform real-time monitoring on ischemic damages for the corresponding functional areas. To elevate the sensitivity of Eps changes for the detection of cerebral ischemia induced by operation, we monitored Motion Evoked Potential ( MEPs), Somatosensory Evoked Potential (SSEPs)and Brainstem Auditory Evoked Potential (BAEPs) in microsurgical operations of intracranial aneurysms. And then the correlation between Eps changes and clinical outcome was investigated.Methods MEPs, SSEPs, and BAEPs were recorded intra-operatively for 25 cases in intracranial aneurysms. Monitored results and clinical outcome were analyzed in a prospective observational design.Results The MEPs in 5 of 21 cases, the SSEPs in 5 of 25 cases and the BAEPs in 1 of 3 cases showed inadequate temporary clipping, inadvertent occlusion, inadequate retraction, vasospasm, or compromise to perforating vessels. 3 patients developed advanced weakness, which showed abnormal SSEPs in only one patient while showed abnormal MEPs in all 3 cases.Conclusions The MEPs is more sensitive than SSEPs in monitoring the motor ischemic impairments. The monitoring results were correlated to the clinical outcome closely. Monitoring Eps in keyhole microsurgery of intracranial aneurysms could improve the sensitivity in detecting insufficient distal collateral flow. And then successful completion of potentially hazardous maneuvers would be attained.

Role of bone marrow stromal cells on rat spinal cord injury by vein transplantation / 中华骨科杂志

Objective To investigate the efficacy of MSCs infused intravenously on the regeneration of injured spinal cord and rehabilitation of its neurological function. Methods 32 SD rats, male or female, weight about 300 g for each one. MSCs were separated, cultured and purified in vitro. Surface marker of MSCs, such as CD34, CD45, CD29 and CD90 were detected by flow cytometry. The rat spinal cord injury model was prepared according to the modified Allen method. After exposure of T10 spinal cord, the T10 segment of spinal cord was injuried by a 10 g weight falling down from 5 cm high place upon a round thin copper pad which was placed on the surface of T10 segment of spinal cord. The diameter of the copper pad is 3 mm. There are 24 rats in the injuried group and 8 in the non-injuried group. The injuried group was then divided into experiment group with 14 rats and control group with 10 rats at 24 hours after preparation of models. The rats in the injuried group and non-injuried group were infused with MSCs marked by Brdu through tail vein, and the rats in control group were infused with PBS. The neurological functions of rats were evaluated at 24 hours after injury and 1, 3, 5 weeks post-infusion respectively. At the same time, the immigration, survival and differentiation of MSCs were observed. Results The MSCs were uniformly CD29, CD90 positive and CD34, CD45 negative. In vivo experiment, transplanted MSCs survived and were localized to the injured spinal cord, and a few cells expressed NSE, MAP2 post transplantation 3 to 5 weeks. Significant improvement in functional outcome in rats treated with MSCs transplantation compared to control rats. The score of BBB in the treated group was higher than that in the control group (P